MRI-Negative Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Antibody Spectrum Demyelinating Disease

Area of Science:

• Neurology
• Immunology
• Pediatrics

Background:

• Myelin oligodendrocyte glycoprotein (MOG) is a key protein in the central nervous system, implicated in various demyelinating disorders.
• Myelin oligodendrocyte glycoprotein antibody spectrum disorder (MOGAD) encompasses a range of clinical and radiological features that are not fully understood.
• Pediatric demyelinating syndromes require accurate diagnosis for effective management and prognosis.

Observation:

• A 9-year-old boy presented with severe immune-mediated myelitis and relapsing MOGAD.
• The myelitis was not detectable by conventional magnetic resonance imaging (MRI) despite significant clinical symptoms.
• The patient experienced substantial clinical improvement after corticosteroid treatment.

Findings:

• This case highlights MOGAD presenting with clinically severe myelitis that is MRI-undetectable.
• Anti-MOG antibody testing is essential for diagnosing MOGAD, even with atypical presentations like seizures.
• Prompt diagnosis and initiation of treatment, such as corticosteroids, can lead to significant symptom improvement.

Implications:

• Serum anti-MOG antibody testing should be considered in children with acute demyelinating syndromes, especially those with unusual clinical features.
• Timely diagnosis and treatment of MOGAD are critical to prevent disease relapse and reduce long-term neurological morbidity.
• This case underscores the importance of considering MOGAD in the differential diagnosis of pediatric acute CNS demyelinating events, irrespective of MRI findings.